M Bruguera

Colegio Oficial de Médicos de Valencia, Valenza, Valencia, Spain

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Publications (340)1580.61 Total impact

  • Miguel Bruguera
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    ABSTRACT: Liver diseases in the elderly have aroused less interest than diseases of other organs, since the liver plays a limited role in aging. There are no specific liver diseases of old age, but age-related anatomical and functional modifications of the liver cause changes in the frequency and clinical behavior of some liver diseases compared with those in younger patients. This review discusses the most important features of liver function in the healthy elderly population, as well as the features of the most prevalent liver diseases in this age group, especially the diagnostic approach to the most common liver problems in the elderly: asymptomatic elevation of serum transaminases and jaundice.
    Gastroenterología y Hepatología 11/2014; DOI:10.1016/j.gastrohep.2014.04.005 · 0.83 Impact Factor
  • Miguel Bruguera
    [Show abstract] [Hide abstract]
    ABSTRACT: Liver diseases in the elderly have aroused less interest than diseases of other organs, since the liver plays a limited role in aging. There are no specific liver diseases of old age, but age-related anatomical and functional modifications of the liver cause changes in the frequency and clinical behavior of some liver diseases compared with those in younger patients. This review discusses the most important features of liver function in the healthy elderly population, as well as the features of the most prevalent liver diseases in this age group, especially the diagnostic approach to the most common liver problems in the elderly: asymptomatic elevation of serum transaminases and jaundice.
  • Journal of Hepatology 04/2014; 60(1):S169. DOI:10.1016/S0168-8278(14)60471-2 · 10.40 Impact Factor
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    ABSTRACT: & Aims: Hy´s Law, which states that hepatocellular drug-induced liver injury (DILI) with jaundice indicates a serious reaction, is widely used to determine risk for acute liver failure (ALF). We aimed to optimize the definition of Hy´s Law and to develop a model for predicting ALF in patients with DILI. We collected data from 771 patients with DILI (805 episodes) from the Spanish DILI registry in Spain, from April 1994 through August 2012. We analyzed data collected at DILI recognition and at the time of peak levels of alanine aminotransferase (ALT) and total bilirubin (TBL). Of the 771 patients with DILI, 32 developed ALF. Hepatocellular injury, female sex, high levels of TBL, and a high ratio of aspartate aminotransferase (AST):ALT were independent risk factors for ALF. We compared 3 ways to use Hy's Law to predict which patients would develop ALF; all included TBL>2-fold the upper limit of normal (xULN) and either ALT>3xULN, an R value (ALT x ULN/ alkaline phosphatase x ULN) ≥5, or an nR value (ALT or AST, whichever produces the highest xULN/ alkaline phosphatase x ULN value) ≥5. At recognition of DILI, the R- and nR-based models identified patients who developed ALF with 67% and 63% specificity, respectively, whereas use of only ALT level identified them with 44% specificity. However, level of ALT and the nR model each identified patients who developed ALF with 90% sensitivity, whereas the R criteria identified them with 83% sensitivity. An equal number of patients who did and did not develop ALF had alkaline phosphatase levels >2xULN. An algorithm based on AST>17.3 x ULN, TBL >6.6 x ULN, and AST:ALT >1.5 identified patients who developed ALF with 82% specificity and 80% sensitivity. When applied at DILI recognition, the nR criteria for Hy's Law provides the best balance of sensitivity and specificity whereas our new composite algorithm provides additional specificity in predicting the ultimate development of ALF.
    Gastroenterology 04/2014; 147(1). DOI:10.1053/j.gastro.2014.03.050 · 13.93 Impact Factor
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    ABSTRACT: To evaluate which of the three studied strategies is the most effective to detect new cases of Hepatitis C virus (HCV) infections in primary care. This is an observational, prospective, and multicentre study evaluating three strategies. Strategy 1: provide an explanatory letter to adults assigned to two primary care teams (PCTs), inviting them to have a blood test. Strategy 2: place posters and leaflets in PCTs advertising the possibility of laboratory tests. Strategy 3: reexamine HCV antibody test results in patients with hypertransaminasemia diagnosed within the last two years through electronic records, and determine anti-HCV status in undiagnosed cases. There were a total 598 participants (51% female with an average age of 50.6±13 years). There were 238 people (4.1% of letters sent) in Strategy 1, 69 people (0.3% of potential participation) in Strategy 2, and 291 people (100% participation) from Strategy 3. One new case of HCV was found in both Strategy 1 and Strategy 2, representing a prevalence of 0.4 and 1.4%, respectively. Two new cases of HCV were found in Strategy 3, representing a prevalence of 0.7%. The three studied strategies for detecting new cases of HCV infection are ineffective, especially in regards to their cost and effort.
    Revista Clínica Española 03/2014; 214(5). DOI:10.1016/j.rce.2014.01.024 · 1.31 Impact Factor
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    ABSTRACT: Antecedentes y objetivo Los premios a la excelencia del Colegio Oficial de Médicos de Barcelona (COMB) fueron instituidos en 2004 para reconocer la excelencia en el ejercicio profesional. Los premiados son elegidos anualmente por jurados nombrados por la junta de gobierno, cuyos miembros proponen médicos que en su opinión tienen un comportamiento profesional y humano ejemplar. Sujetos y métodos Hemos analizado el número de médicos y médicas que han obtenido este reconocimiento y la relación entre el número de varones y mujeres premiados con la distribución por géneros en los jurados. Asimismo se han comparado las edades de médicos y médicas premiados y la de colegiados y colegiadas de más de 45 años. Resultados La relación de varones y mujeres entre los premiados fue de 2,7/1 (rango: 1,2/1 para los premiados en Atención Primaria y 6/1 en el apartado Investigación), con una correlación directa no estadísticamente significativa entre la relación varones/mujeres premiados y jurados. La relación entre varones y mujeres colegiados con más de 45 años fue de 1,4/1, mientras que en los premiados fue de 2,7/1. En los últimos 4 años ha incrementado la proporción de mujeres en los jurados y de forma paralela ha aumentado el número de médicas premiadas. Conclusión El predomino de varones entre los premiados parece relacionarse con la mayor proporción de varones en la composición de los jurados.
    03/2014; 214(2):69–73. DOI:10.1016/j.rceng.2013.12.001
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    ABSTRACT: The awards for the excellence of the Official College of Physicians of Barcelona (COMB) were instituted in 2004 to recognize the excellence of the professional exercise. The winners are yearly chosen by juries appointed by the board of government, whose members propose for the award doctors who, in their opinion, have an exemplary professional and human behaviour. The number of male and female doctors who have obtained this recognition has been analysed in relation with the sex distribution in the juries. Likewise it has been compared the ratios men-to-women of those who have been rewarded and this ratio among physicians of more than 45 years. Between the awarded physicians the ratio men-to-women was of 2.7/1 (range, from 1.2/1 for awardees in primary care to 6/1 in research). The men-to-women ratio among those who were awarded was in parallel to the man-to-women ratios of the juries. The ratio between men and women among members of the COMB of more than 45 years was 1.4/1, whereas in those who were awarded it was of 2.7/1. The increase in the proportion of women in the juries in the last four years has been followed by an increase in the number of female physicians awarded. This data demonstrates that the predominance of male doctors among those who were awarded does not depend so much on the age factor, but basically on the proportion of male and female doctors in the juries.
    Revista Clínica Española 11/2013; DOI:10.1016/j.rce.2013.10.008 · 1.31 Impact Factor
  • Cristian Cerda, Miguel Bruguera, Albert Parés
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    ABSTRACT: Glucosamine and chondroitin sulfate are molecules involved in the formation of articular cartilage and are frequently used for symptom relief in patients with arthrosis. These molecules are well tolerated with scarce secondary effects. Very few cases of possible hepatotoxicity due to these substances have been described. The aim of this paper is to report the frequency of presumed glucosamine hepatotoxicity in patients with liver disease. A questionnaire was given to 151 consecutive patients with chronic liver disease of different etiology (mean age 59 years, 56.9% women) attended in an outpatient clinic with the aim of evaluating the frequency of consumption of these drugs and determine whether their use coincided with a worsening in liver function test results. Twenty-three patients (15.2%) recognized having taken products containing glucosamine or chondroitin sulfate previously or at the time of the questionnaire. Review of the clinical records and liver function tests identified 2 patients presenting an elevation in aminotransferase values temporarily associated with glucosamine treatment; one of the cases simultaneously presented a skin rash attributed to the drug. Review of these two patients and the cases described in the literature suggest toxicity of glucosamine and chondroitin sulfate. The clinical spectrum is variable, and the mechanism of toxicity is not clear but may involve reactions of hypersensitivity. The consumption of products containing glucosamine and/or chondroitin sulfate is frequent among patients with chronic liver diseases and should be taken into account on the appearance of alterations in liver function tests not explained by the underlying disease.
    World Journal of Gastroenterology 08/2013; 19(32):5381-4. DOI:10.3748/wjg.v19.i32.5381 · 2.43 Impact Factor
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    ABSTRACT: Ursodeoxycholic acid (UDCA) is the standard treatment for primary biliary cirrhosis (PBC) but excellent response is not observed in all cases. Since potential favourable effects of fibrates have been reported in short series with inconclusive results, we have carried out a pilot study to analyse the effects of bezafibrate in patients with suboptimal response to UDCA. Thirty women (age 52.3 ± 2.3 years) treated with UDCA and abnormal alkaline phosphatase (AP) levels received bezafibrate (400 mg/d) for 1 year. Changes were measured every 3 months during the study period of 12 months, 3 months after discontinuation and 3 months after resuming bezafibrate. Two patients discontinued the treatment after few days, three at 6 and one at 9 months. Bezafibrate treatment resulted in a significant decrease in AP as early as 3 months. Normalization or decrease of AP below 1.5 times normal levels was observed in 13 and 4 patients respectively. There was also a significant decrease in γ-glutamyl transferase and alanine aminotransferase, cholesterol and triglyceride levels. Bezafibrate treatment resulted in significant improvement of pruritus. A rebound in liver biochemistries and pruritus occurred upon drug discontinuation, changes which improved again after resuming bezafibrate. Response to bezafibrate was associated with lower liver stiffness and severity of cholestasis. No severe adverse effects were observed. Combination treatment of bezafibrate and UDCA is associated with marked decrease or normalization of alkaline phosphatase as early as 3 months in patients with PBC. Better biochemical response was observed in patients with early disease and lower cholestasis.
    Liver international: official journal of the International Association for the Study of the Liver 07/2013; 34(2). DOI:10.1111/liv.12290 · 4.41 Impact Factor
  • Miguel Bruguera, Juan G. Abraldes
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    ABSTRACT: The present article aims to provide answers to questions frequently asked by physicians attending patients with Wilson's disease (WD) or those with a suspected diagnosis of WD. The article is divided into 2 parts: a first part with answers to questions relating to the diagnosis of this entity and a second with answers to questions concerning treatment. A brief appendix is included with responses to questions not falling into either of these 2 categories.
    Gastroenterología y Hepatología 05/2013; 36(5):316–325. DOI:10.1016/j.gastrohep.2012.10.003 · 0.83 Impact Factor
  • Medicina Clínica 04/2013; 141(7). DOI:10.1016/j.medcli.2013.02.025 · 1.25 Impact Factor
  • Miguel Bruguera, Juan G Abraldes
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    ABSTRACT: The present article aims to provide answers to questions frequently asked by physicians attending patients with Wilson's disease (WD) or those with a suspected diagnosis of WD. The article is divided into 2 parts: a first part with answers to questions relating to the diagnosis of this entity and a second with answers to questions concerning treatment. A brief appendix is included with responses to questions not falling into either of these 2 categories.
    Gastroenterología y Hepatología 04/2013; · 0.83 Impact Factor
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    ABSTRACT: Precedents and aim The awards for the excellence of the Official College of Physicians of Barcelona (COMB) were instituted in 2004 to recognize the excellence of the professional exercise. The winners are yearly chosen by juries appointed by the board of government, whose members propose for the award doctors who, in their opinion, have an exemplary professional and human behaviour. Subjects and methods The number of male and female doctors who have obtained this recognition has been analysed in relation with the sex distribution in the juries. Likewise it has been compared the ratios men-to-women of those who have been rewarded and this ratio among physicians of more than 45 years. Results Between the awarded physicians the ratio men-to-women was of 2.7/1 (range, from 1.2/1 for awardees in primary care to 6/1 in research). The men-to-women ratio among those who were awarded was in parallel to the man-to-women ratios of the juries. The ratio between men and women among members of the COMB of more than 45 years was 1.4/1, whereas in those who were awarded it was of 2.7/1. The increase in the proportion of women in the juries in the last four years has been followed by an increase in the number of female physicians awarded. Conclusion This data demonstrates that the predominance of male doctors among those who were awarded does not depend so much on the age factor, but basically on the proportion of male and female doctors in the juries.
    Revista Clínica Española 01/2013; · 1.31 Impact Factor
  • Source
    Annals of hepatology: official journal of the Mexican Association of Hepatology 07/2012; 11(4):544-9. · 2.19 Impact Factor
  • Source
    M. Bruguera
    Revista Clínica Española 06/2012; 212(6):311–316. DOI:10.1016/j.rce.2012.05.001 · 1.31 Impact Factor
  • M Bruguera
    Revista Clínica Española 06/2012; 212(6):311-6. · 1.31 Impact Factor
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    ABSTRACT: Claims due to presumed medical malpractice are increasing in all developed countries and many of them have no basis. To prevent legal complaints, the physicians should know the reasons why complaints are made by their patients and adopt the adequate preventive measures. In the case of a complaint, it is essential to follow the guidelines that allow for adequate legal defense and the action of the physician before the judge that inspires confidence and credibility.The risk of the claims can be reduced with adequate information to the patient, the following of the clinical guidelines, control of the risk factors and adoption of verification lists in each invasive procedure.In case of complication or serious adverse effect, explanations should be given to the patient and family and it should be reported to the facility where one works and to the insurance company.If the physician received a claim, he/she should report it to the insurance compare so that it can name a lawyer responsible for the legal defense who will advise the physician regarding the appearance in court before the judge.
    Revista Clínica Española 04/2012; 212(4):198–205. DOI:10.1016/j.rce.2011.12.018 · 1.31 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Claims due to presumed medical malpractice are increasing in all developed countries and many of them have no basis. To prevent legal complaints, the physicians should know the reasons why complaints are made by their patients and adopt the adequate preventive measures. In the case of a complaint, it is essential to follow the guidelines that allow for adequate legal defense and the action of the physician before the judge that inspires confidence and credibility. The risk of the claims can be reduced with adequate information to the patient, the following of the clinical guidelines, control of the risk factors and adoption of verification lists in each invasive procedure. In case of complication or serious adverse effect, explanations should be given to the patient and family and it should be reported to the facility where one works and to the insurance company. If the physician received a claim, he/she should report it to the insurance compare so that it can name a lawyer responsible for the legal defense who will advise the physician regarding the appearance in court before the judge.
    Revista Clínica Española 03/2012; 212(4):198-205. · 1.31 Impact Factor
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    ABSTRACT: Drug-induced liver damage is one of the most complex liver diseases due to its similar presentation to other acute or chronic liver processes, its potential severity and the absence of specific biomarkers to confirm diagnosis, which is based on clinical suspicion and exclusion of alternative causes. Because the drug development process fails to completely screen out hepatotoxic molecules and identify susceptible individuals, postmarketing pharmacovigilance remains essential. Hepatotoxicity registries are the ideal instrument for systematic and continual data collection, using preestablished criteria based on consensus. The present article briefly describes the contributions of the Spanish Hepatotoxicity Registry and those of other international registries. Hopefully, Latin American registries will be incorporated into existing initiatives, which will stimulate research and improve understanding of the complex mechanisms involved in this adverse reaction.
    Gastroenterology 05/2011; 34(5):361-368. DOI:10.1016/j.gastrohep.2011.01.003 · 13.93 Impact Factor
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    ABSTRACT: Drug-induced liver damage is one of the most complex liver diseases due to its similar presentation to other acute or chronic liver processes, its potential severity and the absence of specific biomarkers to confirm diagnosis, which is based on clinical suspicion and exclusion of alternative causes. Because the drug development process fails to completely screen out hepatotoxic molecules and identify susceptible individuals, postmarketing pharmacovigilance remains essential. Hepatotoxicity registries are the ideal instrument for systematic and continual data collection, using preestablished criteria based on consensus. The present article briefly describes the contributions of the Spanish Hepatotoxicity Registry and those of other international registries. Hopefully, Latin American registries will be incorporated into existing initiatives, which will stimulate research and improve understanding of the complex mechanisms involved in this adverse reaction.
    Gastroenterología y Hepatología 03/2011; 34(5):361-8. · 0.83 Impact Factor

Publication Stats

4k Citations
1,580.61 Total Impact Points

Institutions

  • 2013–2014
    • Colegio Oficial de Médicos de Valencia
      Valenza, Valencia, Spain
  • 2009–2014
    • Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas
      Barcino, Catalonia, Spain
  • 1985–2014
    • Hospital Clínic de Barcelona
      • • Servicio de Hepatología
      • • Servicio de Hematología
      • • Servicio de Medicina Preventiva y Epidemiología
      Barcino, Catalonia, Spain
    • Hospital Santa Cruz
      San Paulo, São Paulo, Brazil
  • 1971–2013
    • University of Barcelona
      • Department of Medicine
      Barcino, Catalonia, Spain
  • 2012
    • Hospital Provincial del Centenario de Rosario
      Rosario, Santa Fe, Argentina
  • 2011
    • University of Malaga
      • Facultad de Medicina
      Málaga, Andalusia, Spain
  • 2008
    • Hospital Universitario La Paz
      Madrid, Madrid, Spain
  • 1990–2008
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
  • 2006
    • Hospital Universitario San Cecilio
      Granata, Andalusia, Spain
  • 1998–2001
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain
  • 1999
    • University Hospital Vall d'Hebron
      • Department of Preventive Medicine and Epidemiology
      Barcino, Catalonia, Spain
  • 1994–1996
    • Parc de Salut Mar
      Barcino, Catalonia, Spain
  • 1992
    • Navy Environmental & Preventive Medicine Unit Five
      San Diego, California, United States
  • 1991
    • Roche
      Bâle, Basel-City, Switzerland
  • 1989
    • Hospital Clínico, Maracaibo
      Maracaibo, Estado Zulia, Venezuela